The floods in Pakistan and droughts in sub-Saharan Africa are the bookends around the lethal hardships that millions around the globe live with daily: lack of access to clean, reliable water and sanitation.

Last year the United States spent $774 million to help 62 developing countries deal with their water problems, including $48 million for U.S. Agency for International Development projects in Pakistan. The emergency assistance the United States is now pouring into that flood-stricken country will push water and sanitation aid totals for 2010 even higher.

“Quite often tragic events drive a lot of the commitment of these funds,” said Christian Holmes, a USAID senior adviser for energy and environment.

Droughts and floods affect more people than all other natural disasters combined, and unsafe water causes more deaths than wars, according to the World Health Organization (WHO). More than 1.7 million lives are lost each year from the consequences of living without potable water and having no place to dispose of waste. The youngest are most vulnerable: Ninety percent of those who have perished never saw their 5th birthday, according to the WHO.

A cornerstone of the Millennium Development Goals, set by the United Nations nearly a decade ago, is to cut in half by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation. The United States has boosted spending to help meet that goal, acting on its own through USAID and the Millennium Challenge Corporation (MCC) and with multilateral development banks.

In 2002, then-President George W. Bush unveiled at the World Summit on Sustainable Development in Johannesburg, South Africa, a three-year, $970 million Water for the Poor initiative. After that was spent, Congress in 2005 gave the issue further impetus with passage of the Water for the Poor Act, which requires the secretary of state “to further the United States foreign assistance objective to provide affordable and equitable access to safe water and sanitation in developing countries” and to report back each year.

The State Department’s fifth progress report to Congress, released August 13, charts growth in spending on clean water and a shift in emphasis at USAID toward providing safe drinking water, sanitation and hygiene, the so-called “WASH” activities.

USAID spent almost $600 million on water projects in 2009, up from $400 million two years earlier. Eighty percent was for WASH projects, with the rest going toward water-resource management, irrigation and other efforts to make water systems productive, and reduction of the risk of disasters.

“Water represents one of the great diplomatic and development opportunities of our time,” Secretary of State Hillary Rodham Clinton said in a March 22 speech marking World Water Day. “It’s not every day you find an issue where effective diplomacy and development will allow you to save millions of lives, feed the hungry, empower women, advance our national security interests, protect the environment, and demonstrate to billions of people that the United States cares, cares about you and your welfare. Water is that issue.”

The 62 countries with projects under way in 2009 are spread across Africa, Asia, Eastern Europe, Latin America and the Middle East. USAID targets sustainable projects “that involve low-tech solutions such as water purification, public taps, small-scale piped water, tube wells, small sewer systems, septic tanks and hygienic latrines,” the report to Congress says.

At Congress’s instigation, more money in recent years flows to drought-stricken sub-Saharan Africa. Holmes said that in 2005, only $10 million of the agency’s clean-water grants went to Africa. Last year $96 million went to African countries. Sudan received $39 million of that.

Holmes said the steady growth of funding means that USAID now has more in-house expertise on how to develop clean water and that translates into better programs.

The MCC, an independent agency created by Congress in 2004 to work with poor countries on economic development, strikes five-year compacts with countries to fund their highest-priority projects. Roads, health and agriculture take precedence over water problems in some countries, but the MCC has funded almost $1.3 billion in water and sanitation projects since 2005.

Omar S. Hopkins, associate director for infrastructure, said there are major water-supply and sanitation components to the MCC’s compacts with Mozambique, Tanzania and Lesotho, and a compact soon to be signed with Jordan also will emphasize water. Hopkins said it is easier to secure support for clean-water projects than for sanitation. “Water is kind of a private good. People are much more willing to pay for it,” said Hopkins, a civil engineer who has worked on water projects across Africa, Latin America, the Middle East and South Asia.

The State Department’s report to Congress offers analysis of the water problems in 34 countries, as well as appraisals of the effectiveness of U.S. aid.

Overall, U.S. efforts in 2009 brought safe drinking water to 5.7 million people and sanitation to 1.3 million people.

There is still far to go. The WHO estimates 800 million people lack access to safe water and 2 billion people worldwide live without basic sanitation, and experts predict that by 2025 the water supply in two-thirds of all countries will be under stress.